Effects of physical activity and air pollution on blood pressure

doi:10.1016/j.envres.2019.03.032

Environmental Research

Volume 173, June 2019, Pages 387-396

https://doi.org/10.1016/j.envres.2019.03.032 Get rights and content

Highlights

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Effects of black carbon and physical activity on blood pressure were assessed.
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Physical activity was associated with a decrease in systolic blood pressure levels.
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We did not find a consistent main effect of black carbon on blood pressure.
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We did not find an interaction between black carbon and physical activity.

Abstract

Aim

To assess the main and interaction effects of black carbon and physical activity on arterial blood pressure in a healthy adult population from three European cities using objective personal measurements over short-term (hours and days) and long-term exposure.

Methods

A panel study of 122 healthy adults was performed in three European cities (Antwerp, Barcelona, and London). In 3 seasons between March 2015 and March 2016, each participant wore sensors for one week to objectively measure their exposure to black carbon and monitor their physical activity continuously. Blood pressure was assessed three times during the week: at the beginning (day 0), in the middle (day 4), and at the end (day 7). Associations of black carbon and physical activity with blood pressure and their interactions were investigated with linear regression models and multiplicative interaction terms, adjusting for all the potential confounders.

Results

In multiple exposure models, we did not see any effects of black carbon on blood pressure but did see effects on systolic blood pressure of moderate-to-vigorous physical activity effect that were statistically significant from 1 h to 8 h after exposure and for long-term exposure. For a 1METhour increase of moderate-to-vigorous physical activity, the difference in the expected mean systolic blood pressure varied from −1.46 mmHg (95%CI -2.11, −0.80) for 1 h mean exposure, to −0.29 mmHg (95%CI -0.55, −0.03) for 8 h mean exposure, and −0.05 mmHg (95%CI -0.09, −0.00) for long-term exposure. There were little to no interaction effects.

Conclusions

Results from this study provide evidence that short-term and long-term exposure to moderate-to-vigorous physical activity is associated with a decrease in systolic blood pressure levels. We did not find evidence for a consistent main effect of black carbon on blood pressure, nor any interaction between black carbon and physical activity levels.

Introduction

In 2016, high systolic blood pressure was classified as the third leading risk factor for global burden of disease, causing 10.4 million deaths and 212.1 million disability-adjusted life years (DALYs) (GBD 2016 Risk Factors Collaborators, 2017). High blood pressure has been defined as the strongest modifiable risk factor for cardiovascular disease and related disability worldwide (Olsen et al., 2016). An increase of blood pressure levels can be due to several factors.

An important determinant of blood pressure levels is physical activity. Physical activity is known to reduce the risk of many adverse health outcomes, partly because of its beneficial influence on systemic inflammation (Zhang et al., 2017). Regular physical activity reduces risk of cardiovascular events, and it has also been suggested that physical activity attenuates the air pollution-related increases in blood pressure (Kubesch et al., 2015). Having low physical activity accounted for 1.4 million deaths and 24.3 million DALYs in 2016, and was classified as the 14th risk factor in terms of global DALYs (GBD 2016 Risk Factors Collaborators, 2017). Also, sedentary behaviours have been increasingly associated with health conditions such as obesity, diabetes, metabolic syndrome, cardiovascular disease, and death (Same et al., 2016).

In addition, long-term and short-term exposure to air pollution has been suggested as an important environmental risk factor associated with an increase in blood pressure levels (Louwies et al., 2015; Magalhaes et al., 2018; Yang et al., 2018), and also with other cardiovascular outcomes such as hypertension, heart failure hospitalisation and mortality, decreases in heart-rate variability, and progression in coronary calcification (Chen et al., 2015; Fuks et al., 2016, 2014; Kaufman et al., 2016; Requia et al., 2017; Shah et al., 2013; Weichenthal et al., 2014a; Zhao et al., 2014). In 2016, air pollution was classified as the fifth leading risk factor for global burden of disease, with ambient particulate matter pollution as the most important cause of disease among environmental risk factors, leading 4.0 million deaths and 105.7 million DALYs (GBD 2016 Risk Factors Collaborators, 2017).

Most evidence supports a positive association between air pollution and blood pressure (Magalhaes et al., 2018; Yang et al., 2018). But some studies of specific traffic-related pollutants such as black carbon show no association (Chung et al., 2015; Weichenthal et al., 2014b; Williams et al., 2012) or even inverse associations (Mirowsky et al., 2015). The majority of these studies used measures from fixed monitoring stations, possibly leading to exposure measurement error, and hence null effects. The literature on physical activity and benefits in blood pressure level is mostly consistent (Cornelissen et al., 2011). But we found only one study assessing the effects of traffic-related air pollution and physical activity and their interaction effects with blood pressure (Kubesch et al., 2015). The study found independent opposite effects of traffic-related air pollutants and physical activity on blood pressure, and only evidence for an interaction between physical activity and PM₁₀ and PM_coarse leading to increased systolic blood pressure.

There is a need to better understand the association between air pollution, including black carbon and blood pressure levels, using other, and probably better air pollution measurement methods such as personal monitoring. Moreover, there is a need to better understand the interaction between black carbon and physical activity and its effects on blood pressure using varying urban environments and well-designed observational studies, as the study found with similar design had a very small sample size (28 healthy adults), and it was done in one city.

The main aim of this study was to assess the main and interaction effects of black carbon and physical activity on systolic and diastolic blood pressure, in a healthy adult population from three European cities using objective personal measurements over short-term (hours and days) and long-term exposure.

Section snippets

Study design and population

A panel study was performed in three European cities (Antwerp, Barcelona, and London) as part of the PASTA (Physical Activity through Sustainable Transport Approaches) project (Gerike et al., 2016). Participants were recruited from the PASTA longitudinal study (Dons et al., 2015), in which they answered an online survey on transport, physical activity, and health, and expressed their willingness to participate in a sub-study using sensors. Participants had to fulfil the following inclusion

Results

From the total of 122 healthy adults who participated in the study, 119 completed all three measurement weeks; one participant completed two measurement weeks, and two participants completed one week of measurement. Sociodemographic characteristics, exposure and outcome measures are presented in Table 2.

Fig. 1, Fig. 2, Fig. 3 show the results of single and multiple exposure models evaluating associations between black carbon and physical activity measures with systolic and diastolic blood

Summary of results

In this fairly large study with objective short-term (hours and days) and long-term personal measurements in a healthy adult population, we found that in single exposure models, black carbon was associated with lower levels of systolic blood pressure after 1–4 h of exposure. Moderate-to-vigorous physical activity was associated with lower levels of systolic blood pressure after 1 h to 8 h of exposure, after 12 h of exposure, after 4 days of exposure, and after long-term exposure. In multiple

Conclusions

The results from this study provided evidence that short-term and long-term exposure to moderate-to-vigorous physical activity is associated with a decrease in systolic blood pressure levels. We did not find evidence for a consistent main effect of black carbon on blood pressure, nor for interaction effects between black carbon and physical activity levels.

Funding

This work was supported by the European project PASTA, which had partners in London, Rome, Antwerp, Örebro, Vienna, Zurich, and Barcelona. PASTA (http://www.pastaproject.eu/) was a 4-year project funded by the European Union’s Seventh Framework Program under EC-GA No. 602624-2 (FP7-HEALTH-2013-INNOVATION-1). ML was supported by a VITO PhD scholarship (project number 1410533; www.vito.be). ED was supported by a postdoctoral scholarship from FWO Research Foundation Flanders (grant number: 12L8815N

Declarations of interest

None.

Acknowledgements

ISGlobal is a member of the CERCA Programme, Generalitat de Catalunya. The authors are grateful to the participants of the Physical Activity through Sustainable Transportation Approaches (PASTA) Health add-on study. We would like to acknowledge David Martínez, Esther Gracia, and Sandra Márquez for their help with the statistical analyses; and Elisa Pasqual for her help in the better understanding of the biological mechanisms, by which air pollutants cause cardiovascular effects.

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We observed the beneficial effects of PA on HF remained regardless of levels of PM2.5 exposure, highlighting the important role of PA in the prevention of HF. Our finding is similar with previous studies which suggested that the benefits of PA counterbalanced the deleterious effects of air pollution for health outcomes such as blood pressure(Avila-Palencia et al., 2019), respiratory diseases (Fisher et al., 2016), myocardial infarction (Kubesch et al., 2018), and mortality (Andersen et al., 2015). However, some studies also reported that air pollution could counteract the benefits of PA (Endes et al., 2017; Guo et al., 2020).
Evidence supporting the adverse effects of air pollution and the benefits of physical activity (PA) on heart failure (HF) has continued to grow. However, their joint effects remain largely unknown.
Our investigation included a total of 321,672 participants free of HF at baseline from the UK Biobank. Participants were followed up till March 2021. Information on participants' PA levels and additional covariates was collected by questionnaire. The annual fine particulate matter (PM_2.5) concentration was estimated using a Land Use Regression (LUR) model. Cox proportional hazards models were used to assess the associations of PA and PM_2.5 exposure with incident HF, as well as their interaction on both additive and multiplicative scales.
During a median follow-up of 12.0 years, 8212 cases of HF were uncovered. Compared with participants with low PA, the hazard ratios (HRs) were 0.69 (95 % CI: 0.65, 0.73) and 0.61 (95 % CI: 0.58, 0.65) for those with moderate and high PA, respectively. PM_2.5 was associated with an elevated risk of incident HF with an HR of 1.11 (95 % CI: 1.08, 1.14) per interquartile range (IQR) increment. The synergistic additive interaction between low PA and high PM_2.5 exposure on HF was observed. Compared with participants with high PA and low PM_2.5 exposure, those with low PA and high PM_2.5 exposure had the highest risk of HF [HR (95 % CI): 1.90 (1.76, 2.06)].
Our findings indicate that PA might still be an appropriate strategy to prevent HF for those living in areas with relatively high air pollution. Individuals with low PA may pay more attention to air pollution.
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Participants took part in three separate full weeks of data collection, each taking place in a different season (Spring/Fall, Summer and Winter). They were instructed during measurement weeks to keep an activity diary and wear at all times devices that tracked their location and measured BC and GSR among other things (details to follow, see also Avila-Palencia et al., 2019; Laeremans et al., 2018a; Laeremans et al., 2018b). A combination of physical activity, GPS and travel diary data were used to derive travel time and mode identification (Orjuela, 2018).
Previous research has shown that walking and cycling could help alleviate stress in cities, however there is poor knowledge on how specific microenvironmental conditions encountered during daily journeys may lead to varying degrees of stress experienced at that moment. We use objectively measured data and a robust causal inference framework to address this gap. Using a Bayesian Doubly Robust (BDR) approach, we find that black carbon exposure statistically significantly increases stress, as measured by Galvanic Skin Response (GSR), while cycling and while walking. Augmented Outcome Regression (AOR) models indicate that greenspace exposure and the presence of walking or cycling infrastructure could reduce stress. None of these effects are statistically significant for people in motorized transport. These findings add to a growing evidence-base on health benefits of policies aimed at decreasing air pollution, improving active travel infrastructure and increasing greenspace in cities.
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High-intensity interval exercise (HIIE) is an effective non-pharmacological tool for improving physiological responses related to health. When HIIE is performed in urban centers, however, the exerciser is exposed to traffic-related air pollution (TRAP), which is associated with metabolic, anti-inflammatory imbalance and cardiovascular diseases. This paradoxical combination has the potential for conflicting health effects. Thus, the aim of this study was to determine the effects of HIIE performed in TRAP exposure on serum cytokines, non-target metabolomics and cardiovascular parameters. Fifteen participants performed HIIE in a chamber capable to deliver filtered air (FA condition) or non-filtered air (TRAP condition) from a polluted site adjacent to the exposure chamber. Non-target blood serum metabolomics, blood serum cytokines and blood pressure analyses were collected in both FA and TRAP conditions at baseline, 10 min after exercise, and 1 h after exercise. The TRAP increased IL-6 concentration by 1.7 times 1 h after exercise (p < 0.01) and did not change the anti-inflammatory balance (IL-10/TNF-α ratio). In contrast, FA led to an increase in IL-10 and IL-10/TNF-α ratio (p < 0.01), by 2.1 and 2.3 times, respectively. The enrichment analysis showed incomplete fatty acid metabolism under the TRAP condition (p < 0.05) 10 min after exercise. There was also an overactivity of ketone body metabolism (p < 0.05) at 10 min and at 1 h after exercise with TRAP. Exercise-induced acute decrease in systolic blood pressure (SBP) was not observed at 10 min and impaired at 1 h after exercise (p < 0.05). These findings reveal that TRAP potentially attenuates health benefits often related to HIIE. For instance, the anti-inflammatory balance was impaired, accompanied by accumulation of metabolites related to energy supply and reduction to exercise-induced decrease in SBP.
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We found short-term PM_2.5 exposure damaged executive function (β_PM25 = 0.0064, p = 0.039) but physical activity could counterbalance it (β_MVPA = −0.0047, p = 0.048), whereby beta-3 wave played as a potential mediating role. MVPA-induced improvement on executive function was larger in polluted air (β_MVPA = −0.010, p = 0.035) than that in clean air (β_MVPA = −0.003, p = 0.45). To offset the negative effect of air pollution on cognitive function, individuals should do extra 13.6 min MVPA every day for every 10 μg/m³ increase in daily PM_2.5.
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Citation Excerpt :
Travel time and mode identification were derived from the combination of physical activity, GPS and diary data. More details can be found in Avila-Palencia et al. 2019; Laeremans et al. 2018a; Laeremans et al. 2018b. GSR, measured minute by minute on our participants throughout their three weeks of participation in the study, is our response variable.
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To evaluate effects of daily travel in different modes on an objective proxy measure of stress, the galvanic skin response (GSR).
We collected data from 122 participants across 3 European cities as part of the Physical Activity through Sustainable Transport Approaches (PASTA) study, including: GSR measured every minute alongside confounders (physical activity, near-body temperature) during three separate weeks covering 3 seasons; sociodemographic and travel information through questionnaires. Causal relationships between travel in different modes (the “treatment”) and stress were established by using a propensity score matching (PSM) approach to adjust for potential confounding and estimating linear mixed models (LMM) with individuals as random effects to account for repeated measurements. In three separate analyses, we compared GSR while cycling to not cycling, then walking to not walking then motorized (public or private) travel to any activity other than motorized travel.
Depending on LMM formulations used, cycling reduces 1-minute GSR by 5.7% [95% CI: 2.0–16.9%] to 11.1% [95% CI: 5.0–24.4%] compared to any other activity. Repeating the analysis for other modes we find that: walking is also beneficial, reducing GSR by 3.9% [95% CI: 1.4–10.7%] to 5.7% [95% CI: 2.6–12.3%] compared to any other activity; motorized mode (private or public) in reverse increases GSR by up to 1.1% [95% CI: 0.5–2.9%].
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We performed three 24-h personal exposure measurements for UFP, PM_2.5, and soot in 132 healthy adults from Basel (Switzerland), Amsterdam and Utrecht (the Netherlands), and Turin (Italy). Monitoring of each subject was conducted in different seasons in a one-year study period. Subject's activity levels and associated ventilation rates were measured using actigraphy to calculate the inhaled dose. After each 24-h monitoring session, blood pressure and lung function were measured. Contemporaneously with personal measurements, UFP, PM_2.5 and soot were measured outdoor at the subject's residential address and at a central site in the research area. Associations between short-term personal and outdoor exposure and dose to UFP, PM_2.5, and soot and health outcomes were tested using linear mixed effect models.
The 24-h mean personal, residential and central site outdoor UFP exposures were not associated with blood pressure or lung function. UFP mean exposures in the 2-h prior to the health test was also not associated with blood pressure and lung function. Personal, central site and residential PM_2.5 exposure were positively associated with systolic blood pressure (about 1.4 mmHg increase per Interquartile range). Personal soot exposure and dose were positively associated with diastolic blood pressure (1.2 and 0.9 mmHg increase per Interquartile range). No consistent associations between PM_2.5 or soot exposure and lung function were observed.
Short-term personal, residential outdoor or central site exposure to UFP was not associated with blood pressure or lung function. Short-term personal PM_2.5 and soot exposures were associated with blood pressure, but not lung function.

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Effects of physical activity and air pollution on blood pressure

Highlights

Abstract

Aim

Methods

Results

Conclusions

Introduction

Section snippets

Study design and population

Results

Summary of results

Conclusions

Funding

Declarations of interest

Acknowledgements

J. Sci. Med. Sport

Environ. Res.

Lancet

Sci. Total Environ.

Environ. Int.

Environ. Res.

Lancet

Lancet

Environ. Pollut.

Effects of particulate air pollution on blood pressure in a highly exposed population in Beijing, China: a repeated-measure study

Environ. Heal.

Calibration and validation of wearable monitors

Med. Sci. Sports Exerc.

Associations between long-term air pollutant exposures and blood pressure in elderly residents of Taipei city: a cross-sectional study

Environ. Health Perspect.

Association of PNC, BC, and PM2.5 measured at a central monitoring site with blood pressure in a predominantly near highway population

Int. J. Environ. Res. Public Health

Impact of resistance training on blood pressure and other cardiovascular risk factors: a meta-analysis of randomized, controlled trials

Hypertension

Physical activity through sustainable transport Approaches (PASTA): protocol for a multi-centre, longitudinal study

BMC Public Health

Long-term exposure to ambient air pollution and traffic noise and incident hypertension in seven cohorts of the European study of cohorts for air pollution effects (ESCAPE)

Eur. Heart J.

Arterial blood pressure and long-term exposure to traffic-related air pollution: an analysis in the European study of cohorts for air pollution effects (ESCAPE)

Environ. Health Perspect.